Mental health trajectories of immigrant and refugee children: An ecological population-based approach

Canada’s immigrant and refugee population is growing rapidly, representing over 20% of the population. Despite the significance for Canadian society, little is known about mental health and risk factors among immigrant and refugee children and youth. Such knowledge is, however, critical to understand how we can support them in adapting to Canada, and enhance their well-being. This project aims to create actionable evidence that health professionals, educators, and decision-makers can use to implement initiatives that can support the mental health of immigrant and refugee children and youth.

This research will:

  1. Use statistical analyses of multiple databases, linked at a population-level across 10 school districts of BC, to examine how child, family, school, and community factors relate to immigrant and refugee children’s mental health outcomes, and how these children and youth are using health services in BC.
  2. Ask immigrant and refugee youth about their perspectives on factors related to their mental health and access/barriers to mental health services, via interview focus groups in school and mental health clinic settings.

This is the first study in BC to combine province-wide data with children’s own perspectives to identify which factors may need to be addressed and what future prevention and intervention efforts are needed to support long-term health outcomes for immigrant/refugee children and youth in Canada.

End of Award Update – June 2023

Most significant outputs

This project allowed us to study and identify population-level diagnostic prevalence of mental health disorders across immigrant, refugee, and non-immigrant children and youth in British Columbia (BC). In this research, we found notable differences in the diagnostic prevalence rates of conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and mood/anxiety disorders across immigrant, refugee, and non-immigrant children and youth, as well as across factors such as sex, age, and immigrant/refugee generation status.

This project also allowed us to delve more deeply into the factors that might impact the emotional health of refugee children. This research identified that specific factors associated with refugee children’s perceptions of their social context (e.g. a supportive school climate, support from adults at school) were associated with better emotional health.



To our knowledge, our research is the first to provide population-level mental disorder prevalence estimates that compare immigrant, refugee, and non-immigrant groups in BC. This provides important information to our understanding of the mental health status of immigrant and refugee children and youth in BC.


Potential Influence

We hope that this work will be the impetus for additional research examining the unique mental health patterns and needs of diverse child and youth sub-populations that tend to be underrepresented in mental health research. Understanding the unique needs of Canada’s diverse sub-populations is particularly important for health service planning and informing health policies.


Next Steps

With the support of a Tier 2 Canada Research Chair and funding from the Canadian Institutes of Health Research and Social Sciences and Humanities Research Council of Canada, we are continuing our work to deepen our understanding of the developmental trajectories and unique mental health needs of diverse children and youth in BC.

Incentivizing the delivery of sustainable care of chronic diseases in Canada: Case studies in musculoskeletal disease

Concerns about the sustainability of publicly funded health systems and the rising cost of care abound, yet there is little research that explores health care efficiency. Simple cost-saving exercises (i.e. cutting services) may risk harming patients, while more sophisticated, efficiency-saving approaches aim to provide health care at a greater benefit per unit of cost. Encouraging quality and value of health care delivery, whilst reducing waste, is also an indirect way to control health care costs. Undertreatment (failure to use best available care), overtreatment (treatment contrary to best-available evidence or preferences of patients), and poor coordination of care are three key clinical sources of waste. Many large-scale schemes aim to incentivize better health care, but show mixed results.

Dr. Harrison’s research will translate aspects of successful schemes and inform sustainable health care provision in Canada, focusing on musculoskeletal (MSK) diseases as they have been central to successful schemes. MSK diseases affect 11 million Canadians, and contribute hugely to the economic burden of disease in Canada. They have extensive impacts on people’s lives, including their health-related quality of life, ability to work, financial situation and reliance on the health care system. Additionally, high quality care of rheumatic disease requires early access to treatments which are often complex and considerably different from one another. Therefore, it is increasingly recognized that patients need coordinated, multidisciplinary support and care.

Dr. Harrison’s program will encompass policy-focused health economics and outcomes research to inform the design of financial and non-financial incentives to improve the efficiency of health care delivery.

End of Award Update: September 2022

Most exciting outputs

The project allowed me to explore whether a change to introduce a billing code for multidisciplinary care in rheumatology changed the experience of patients visiting rheumatologists in BC. We found that rheumatologists who used multidisciplinary care were able to expand services for patients.


Impacts so far

Our work adds to the evidence around incentives for multidisciplinary care in chronic disease. This will help inform future policy decisions.


Next steps

I continue to work on the evaluation of incentives and changes in policy for health care. I am currently co-leading a project evaluating the biosimilars initiative in BC.


Useful links